Rotator cuff surgery

Rotator cuff surgery aims to relieve pain and allow you to use your shoulder more easily.

Surgeon checking patients arm movement for sign of rotator cuff injury symptoms

Your shoulder is a ‘ball and socket’ joint. It looks a bit like a golf ball resting on a tee. The joint comprises your upper arm (humerus) and your shoulder blade (scapula). The top of your humerus (head of humerus) rests inside the shallow cup-like part of your scapula. This is known as your glenoid.

Your rotator cuff is a group of muscles and tendons that surround your shoulder. These tendons stabilise and strengthen your shoulder socket as you move it. You use your rotator cuff to perform everyday movements without even realising. For example, reaching to put an item on your shelf or stretching your arm behind your back when putting your jacket on. As a result, damage to your rotator cuff can significantly impact your daily life.

You might need rotator cuff repair surgery if you have damaged or torn your rotator cuff. A rotator cuff injury can happen for a number of reasons. The most common symptoms of a rotator cuff injury are:

Pain around the top outer part of your shoulder

You may find this pain gets noticeably worse whenever you lift your arm above shoulder height or reach behind your back

Swelling around the top of your shoulder

this could be a sign of inflammation in the tendon(s) or a bursa (a fluid-filled sac between tissues)

Pain at night

Lying down in bed at night may make your pain worse, as the shoulder moves position.

Other symptoms that indicate a damaged rotator cuff include:

Stiffness
A grating or cracking sound when you move your arm
Persistent pain, even when resting your arm
Pain that cannot be managed with painkillers

Rotator cuff surgery is carried out to repair a torn rotator cuff and/or general rotator cuff damage.

Surgery may be recommended when non-surgical methods, such as physiotherapy or steroid injections, haven’t worked.

The main benefits of rotator cuff surgery are to relieve pain and to allow you to use your shoulder more easily.

Having surgery can restore function, improve your mobility and increase your range of movement.

Ultimately, successful surgery can help you return to your normal activities.

If the tear or impingement is quite small, then the symptoms can often be managed with physiotherapy and/or anti-inflammatory painkillers.

Another non-surgical treatment is steroid injections, which can also help to manage the pain.

However, physiotherapy is usually the first port of call before considering surgery.

If you have a large tear, are experiencing recurring pain, or have limited arm mobility and muscle weakness in the shoulder area, and physiotherapy has failed to control your symptoms, then rotator cuff surgery may be the most appropriate solution.

Depending on the extent of your injury, rotator cuff surgery can be performed as either open surgery or by arthroscopy (also known as keyhole surgery).

Many rotator cuff tears can be carried out using as keyhole surgery. Arthroscopy involves inserting a thin metal tube with a camera and bright light at one end (this is known as an arthroscope) through small cuts made in your shoulder joint. Your consultant insert specialist surgical instruments through the arthroscope and to repair the wear and tear in your shoulder. This involves re-attaching the tendon to the head of your humerus (upper arm bone).

If you have a larger tear, “open” surgery may be required. This involves a larger cut being made over your shoulder and the rotator cuff tear being repaired with stitches and bone anchors.

Arthroscopy involves inserting a small camera, called an arthroscope, through a few small incisions, and passing surgical instruments through these incisions to treat the shoulder joint.

If you have a larger tear, open surgery may be required and a larger cut over your shoulder will be made. Bone spurs may also be removed to prevent the rotator cuff tendons from rubbing against the bone. The surgery itself is usually performed under a general anaesthetic, however a variety of anaesthetic techniques are possible.

During the surgery, your surgeon may use instruments to remove any thickened tissue, release any tight tissue and to shave off some bone.

If you have a large tear, your surgeon will repair the rotator cuff using stitches that anchor into the bone.

Any surgical intervention has risks of complications such as pain and bleeding. Risks and complications of rotator cuff surgery include:

Complications specific to rotator cuff surgery include:

Bleeding into your shoulder
Restricted shoulder movement
Infection in your shoulder
Blood clot
Nerve injury

Your consultant will reassure you by explaining the likelihood of these complications.

The immediate recovery period depends on the type of anaesthetic you’ve been given, but in some cases it’s possible to go home on the same day.

Your ward team and physiotherapist will give you instructions on your post-operative exercise regime and functional advice. Once you’re back in the comfort of your own home, it is important to follow advice on how to keep the surgical wound dry and clean.

To help manage any pain you may experience, your consultant may prescribe pain relief medication. You’ll need to attend regular physiotherapy sessions and perform your prescribed exercises at home.

These exercises will help you to increase your range of movement, function and strength. After approximately two weeks, the stitches or clips can be removed.

However, it can take up to a year to make a full recovery in terms of building enough strength in your shoulder to return to normal activities.

Regular exercise can help to speed up your recovery, but before you start exercising, you should ask a member of the healthcare team for advice.